Stethoscope Contamination: What You Don’t See Can Hurt You

Studies have shown that most physicians and nurses do not disinfect their stethoscopes frequently – 70% to 90% of physicians do not disinfect their stethoscopes after each patient contact. The parts of the stethoscope most likely to come in contact with patients (i.e., the diaphragm and the bell) are almost always contaminated with potential nosocomial pathogens such as staphylococci (up to 32% of the time with MRSA), C difficile, resistant gram-negative bacilli, and sometimes viruses. Stethoscope contamination commonly occurs as a result of contact with infected or colonized patients.

A Swedish study published earlier this year found that ungloved physicians in one hospital who used pre-sterilized stethoscopes on MRSA-colonized patients had become contaminated with MRSA on their fingertips or the diaphragms of their stethoscopes during 76% of the examinations, and there was a strong correlation between the contamination levels on the physicians’ hands and the quantitative level of stethoscope contamination with each examination for both MRSA and total bacterial counts.

But it was not only the diaphragm of the stethoscope on which MRSA was found – the stethoscope tube, which typically does not come in contact with the patient’s skin, had a level of MRSA contamination greater than the contamination level of the physicians’ hand dorsum (back of the hand). The stethoscope tube is likely indirectly contaminated when the tube is manipulated by the physicians’ contaminated hands.

The researchers concluded, “failing to disinfect stethoscopes could constitute a serious patient safety issue akin to omitting hand hygiene. Hence, from infection control and patient safety perspectives, the stethoscope should be regarded as an extension of the physician’s hands and be disinfected after every patient contact. However, the optimal method of disinfection remains to be determined. Alternatively, cross-transmission could be interrupted by assigning stethoscopes to individual patients. Clearly, there is an urgent need to identify effective transmission mitigation strategies … Our findings provide strong evidence of the potential for stethoscope-mediated transmission of microorganisms and the need to systematically disinfect stethoscopes after each use. Consequently, our results may help convince physicians of the importance of proper and timely disinfection. Further studies will be required to better understand microorganism survival on stethoscopes as well as their transmissibility onto a recipient’s skin. Furthermore, additional studies are needed to better understand how stethoscopes can be efficiently and safely disinfected.”

It would be important for patient safety to know how many people become infected with serious infections as a result of the spread of germs by contaminated stethoscopes due to a physician or other health care provider in a hospital, rehabilitation facility, nursing home, or other inpatient facility unwittingly causing the spread of infectious germs. Some hospitals are becoming aware of contaminated stethoscopes as a possible source of infectious spread and have implemented policies calling for ICU patients to be assigned a stethoscope that is used only for his/her care and not used for other patients. While it is unknown the extent to which such policies have avoided ICU patients from becoming infected by contaminated stethoscopes, such policies would not cause harm to ICU patients and perhaps such policies should be considered for other areas of inpatient hospital care.

If you acquired a serious infection during a hospital stay or nursing home care in the United States, you should promptly contact a medical malpractice attorney in your state who may investigate your possible medical malpractice claim for you and represent you in a medical malpractice case, if appropriate.

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